Deep Venous Thrombosis vs Varicose Veins

The two clinical terms are a nightmare for any physician because one can kill a patient, and the other can be managed at home. If you have sore legs, you are tempted to know the difference between DVT and Varicose veins.

DVT stands for Deep Venous Thrombosis while Varicose veins are dilated tortuous veins that appear in the legs. Varicose veins are benign and not harmless unless complication develops. On the contrary, Deep Venous Thrombosis is a medical emergency that requires urgent care and treatment. DVT can be fatal if missed.


What is DVT?

DVT stands for Deep Venous Thrombosis. This a life-threatening condition where a blood clot forms in your body, usually from the lower legs. This can further travel to your lung and cause sudden death.

What are the Dangerous Signs of DVT?

If you have calf swelling and pain on backward bending and contracting of your foot, this is most likely Deep Venous Thrombosis. It is often diagnosed based on Well’s score which is a diagnostic difference between DVT and Varicose veins. This is discussed as follows.

Well’s Score Mnemonic

  • BEST CAP (1 score for each) (-2 for Alternative Diagnosis Likely)
  • Bedridden >3 days/ Past surgery within 12 weeks
  • Entire leg swollen
  • Swelling- Entire leg or Calf Swelling >3cm
  • Tenderness
  • Collateral Superficial Veins
  • Active Cancer
  • Paralysis, Paresis or Plaster, Previous DVT< Pitting Oedema

This acronym was made to help medical students mug up Well’s score for diagnosis of Deep Venous Thrombosis.

Interpretation of Well’s Score

The threshold is set by 2. This is further clarified as follows:

  • When to say DVT Likely or Unlikely?
    • Well’s Score >_2 = DVT Likely
    • Well’s Score <2 = DVT Unlikely

You can have calf discomfort or tightness, as well as swelling, redness, and non-pitting edema (swelling that does not resolve on pressure) of the ankle or legs.

The doctor may test you for Homan’s sign and see if there is an induction of calf pain on dorsiflexion (on backward bending and contracting of your foot) of your foot.

Predisposing factors for DVT include previous heart disease, varicose veins, obesity, long travel, and immobilization for more than 4 days.


The two important points to note:

Phlegmasia cerulae dolens

A cyanotic hue is produced by deoxygenated hemoglobin in sluggish veins.

Phlegmasia alba dolens

In DVT, a significantly edematous limb causes a rise in interstitial pressure that exceeds capillary perfusion pressure. This causes pallor (also known as alba or whiteness) of the limb.

If a diagnosis of Deep Venous Thrombosis is suspected, you will be asked to undergo a series of tests. These will involve D-Dimer level assay, USG or Doppler Ultrasound, Impedance plethysmography, and Venography.

The aim is to prevent the most dangerous complication of DVT- Pulmonary embolism.


Signs of DVT

Clinical signs are landmarks for the difference between DVT and Varicose veins. Having a good grip on these help in making a timely diagnosis.

Homan’s Sign

Elicitation of calf pain on dorsiflexion of the foot

Moses Sign

If pain is induced when the calf muscle is squeezed forwards against the tibia but not when the calf muscle is compressed from side to side, the indication is positive. This sign is also known as Bancroft’s sign. However, sensitivity and specificity are questionable.


Treatment of Deep Venous Thromboembolism

DVT needs early treatment including emergency drugs and swift care to avoid thrombosis and death. The following steps usually involve the management depending on the scenario.

  • Extremity elevation and bed rest are used to treat the condition.
  • In the limb, an elastic stocking may be employed. Anticoagulation is initiated with low molecular weight heparin (LMWH), with a PTT objective of twice normal.
  • When the INR is within the desired range, warfarin is begun immediately and LMWH is terminated (i.e. 2.5)
  • When compared to unfractionated heparin, LMWH does not require coagulation factor monitoring and has a lower risk of bleeding.
  • An NSAID may be used to treat limb discomfort and edema.

Varicose Veins

The varicose vein is a relatively benign condition and mostly does not even require treatment. However, underlying causes must be ruled out to make the diagnosis clear.

Features of Varicose Veins

  • In the lower leg, there are dilated tortuous veins
  • There is discomfort, irritation, or ulceration (medial)
  • Leg heaviness

Pictures

Risk Factors

  • A job involving prolonged standing
  • Pregnancy
  • Obesity
  • Old age>65 years

Investigations

Your doctor may ask for a Duplex Ultrasound to rule out any other concerning cause.

Treatment

There are several treatment options for varicose veins these days. Some of them include:

  • Minimal invasive procedures (preferred)
    • Radiofrequency ablation
    • Endovenous laser therapy
    • Sclerotherapy
  • Surgical removal of the vein
  • Compression hosiery (during pregnancy)

Difference between DVT and Varicose Veins

The differences between Deep Venous Thrombosis and Varicose veins have been summarised as follows:

SymptomVaricose VeinsDVT
Surface temperatureNormalWarm
Peripheral Arterial PulsationNormalAbsent
Calf pain at dorsiflexion of the footNonePresent
EdemaMay be presentMay be present
Cyanosis (blue discoloration)NoneIndicates severe obstruction
Collateral superficial veinsNonePresent

Conclusion

DVT is an extremely crucial diagnosis that demands prompt care and management. If one has any of the signs mentioned above, he should seek care in A&E instantly. This is life-threatening and demands instantaneous intervention.


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